Cardiac Arrest

There were several things I had to write about from my last two days at work. Had I updated when I came home on Friday I would have, but something happened first thing on yesterday's shift that will dominate this blog entry.

I was in resus checking the paediatric bay when a call came in that a cardiac arrest was on its way. The patient was a 62 year old male who had had chest pain for 3 hours. When the LAS got to him he looked very unwell so they got him in the ambulance and left straight for hospital whilst the daughter got changed, the undertone from this was that she didn't seem to realise it was serious. Just before they arrived he had a cardiac arrest and was in PEA (Pulseless Electriacl Activity) on arrival. I asked to observe the resuscitation as I have had no experience with a cardiac arrest.

After one cycle of chest compressions (from a very clever machine that looks a bit like a baby gym with a toilet plunger head hanging below) and ventilation (he was intubated and attached to a ventilator) they got a pulse back and began to try and stabilise him with a whole host of drugs. The team worked efficiently gaining venous access, taking blood tests, inserting a blood pressure monitoring line, observing his vital signs and administering medication. They were switching between two main drugs in an attempt to stabilise his blood pressure as it seesawed between high and low. By this point the family had arrived and been informed that he was a in a critical but stable condition.

He oxygen saturations were dropping and the ventilator was unable to maintain them so they began to bag him and breathe for him, he was making his own respiratory effort but it wasn't adequate. He has pulmonary oedema, probably caused by heart failure, and his lungs were filled with fluid and it was only by bagging him that they could maintain his saturations, though this also began to be less effective.

Then he arrested again, the compression machine was strapped on and they began compression/ventilation cycles again. One of his sons arrived in the room to watch, and even as this machine was forcing his chest up and down I heard the son say "Is it serious?", at this point he still had no concept of how unwell his father was, or perhaps it was the shock. They were unable to restart his heart and the decision was made after almost an hour of attempts to cease; his heart was too badly damaged, his lungs wouldn't inflate because of the fluid and he had been hypoxic at too many points not to have damaged his brain.

I excused myself at this point as the family came in to be with him, it took several explanations for them to understand that he had died and there was nothing they could do. Then the wailing began.

In university someone once told me that it is one of the most privileged positions to be in, being with someone when they die. Although this situation isn't exactly what they meant I understand it. It was incredible to see the human body in its final moments and how it fights to save itself. The team worked so well, they deal with this regularly. It wasn't dignified, but everyone in that room fought, including the patient, to save a life.

It doesn't upset me, whatever I feel is insignificant to the loss that family feels. It was sobering, but I do consider it a privilege. We talk about the wonder of birth, death in its own way is just as amazing. Dying is a part of life, I'm not suggesting we be happy about it or necessarily celebrate it, but I think I have a healthy respect for it.